The Safety of Triptan Use for Migraines in the Elderly (P04.233)

Abstract

Objective: To determine whether the risk of death, myocardial infarction (MI), ischemic heart disease (IHD) and ischemic stroke is increased in elderly migraineurs treated with triptans. Background Because case reports have reported an association between triptans (the first choice treatment for migraines) and stroke, MI, and IHD, healthcare providers are particularly concerned about the safety of these drugs in the elderly. Design/Methods: We developed and validated an electronic algorithm to identify migraineurs, triptan use, cardiovascular risk factors, all-cause mortality and incident cases of MI, IHD, and ischemic stroke from the comprehensive electronic medical records of the Kaiser Permanente Southern California membership over age 65 between 2007 and 2010. Non-migraine controls were matched 4:1 to elderly migraineurs on age, gender and KPSC membership characteristics. Risk estimates were obtained using logistic regression adjusted for age, gender and other cardiovascular risk factors. Results: We identified 27,059 migraineurs over the age of 65 of whom 3726 (13.8%) used triptans. There was no association between triptan use and risk of death (OR=0.73, 95%CI=0.53-1.02), MI (OR=0.86, 95%CI=0.59-1.26), ischemic stroke (OR=1.15, 95%CI=0.84-1.59) or other outcomes studied compared with non-migraine controls. Non-triptan-treated migraineurs had an elevated risk of ischemic stroke (OR=1.41, 95%CI=1.29-1.56) and IHD (OR=1.26, 95%CI=1.17-1.37) but not MI or all-cause mortality (OR=0.98, 95%CI=0.89-1.08) compared with non-migraine controls. Triptan-users had fewer cardiovascular risk factors including less hypertension, hyperlipidemia, diabetes, prior stroke, MI or IHD and lower risks of death (OR=0.64, 95%CI=0.50-0.81) and MI (OR=0.69, 95%CI=0.48-0.98) and less so ischemic stroke (OR=0.76, 95%CI=0.57- 1.02) compared with non-triptan-treated migraineurs. Conclusions: Triptan use in the elderly was not associated with an increased risk of death, MI, IHD or ischemic strokes. However, triptan-users had fewer cardiovascular risk factors, thus it remains unclear whether triptan use is safe in elderly patients with significant cardiovascular risk factors. Additional stratified, and propensity score-adjusted analyses will be presented. Disclosure: Dr. Salem has nothing to disclose. Dr. Chen has nothing to disclose. Dr. Potrebic has nothing to disclose. Dr. Burchette has nothing to disclose. Dr. Langer-Gould has nothing to disclose.